腹腔镜胆囊切除治疗急性胆囊炎312例

Laparoscopic cholecystectomy for acute cholecystitis: report of 312 cases

目的总结腹腔镜胆囊切除术治疗急性胆囊炎的经验。方法 2001年1月至2009年3月,对急性胆囊炎312例采用常规四孔法行腹腔镜胆囊切除术治疗。结果 306例成功完成腹腔镜胆囊切除术;6例中转开腹,其中1例胆囊三角粘连致密,2例术中大出血,1例术中发现胆总管结石,1例胆囊十二指肠瘘,1例Mirizzi综合征。术中无胆管损伤,术后未发生腹腔出血、胆漏及膈下脓肿等并发症。312例术后随访3～24个月,平均12个月,无腹痛、黄疸等不适。结论腹腔镜手术治疗急性胆囊炎是安全可行的,关键是术者必须充分了解腹腔镜胆囊切除术操作要点和熟练掌握操作技术,并把握好中转开腹手术的指征。

Objective To summarize clinical experience of laparoscopic cholecystectomy （LC） for acutecholecystitis. Methods From January 2001 to March 2009, 312 patients with acute cholecystitis underwentLC using 4-port technique in our hospital. Results The LC was successfully completed in 306 cases, theother 6 patients were converted to open surgery because of massive adhesion at the Calot’s triangle （1 case）,severe hemorrhage （2 cases）, choledocholith （1 case）, cholecystoduodenal fistula （1 case）, or Mirizzi syndrome（1 case）. During the operation, no bile duct injury occurred. None of the patients had intra-abdominal hemorrhage, biliary leakage, or subphrenic abscess after the operation. All of patients were followed-up for 3 to 24months with a mean of 12 months, during that time no patient complained of abdominal pain or jaundice.Conclusion LC is safe and feasible in the treatment of acute cholecystitis, and successful surgery should bebased on the skilled techniques and the knowledge of key points in the operation. Conversion to open surgeryis necessary when LC is difficult.